MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 17 - Siren's Song
I bolted upright in my chair. Someone was calling me. Was I asleep?
I turned around. It was the new nurse from the inpatient unit. Her lips were moving energetically but I couldn't connect my brain to her words. I was caught in a fuzzy zone somewhere between this reality and the dream I thought I just had. At that moment I wasn't sure if it was a dream. I looked at the computer monitor. On the screen was "Hello. I'm Siggie. What's your name?"
Slowly, I started to focus.
"... we tried to reach the attending physician, but he wasn't home, and you weren't in the resident's lounge. There wasn't anything we could say to convince him to stay. So he left AMA."
"Who left?" I asked, still confused.
"Like I said - Richard Mobin."
"Oh shit!" I said under my breath and leaped out of my seat. Scurrying down the hallway, trying not to appear too upset to the nurse trailing somewhere behind, I imagined the reactions from Fred and Dr. Stein, when they found out that I had fucked up. Had I fucked up? I wasn't in the resident's lounge, where I said I'd be, but I had done everything I could with Mobin. Hadn't I?
The inpatient unit was quiet, more so than I would have thought. Maybe Mobin left without turning the place upside down. A few groups were huddled together, buzzing softly, probably discussing the incident. The head nurse saw me as I entered. She did not look happy. I struggled to get her name onto my tongue, but I just couldn't recall it. She looked like a....Natalie... no.... a Cleopatra. God, that's not right! What a time to block!
"I'm sorry you couldn't find me," I said quietly. "What happened?"
"Well, your patient was in his room for a while, sitting on his bed. He was tying knots into a piece of string. Then he just got up, came over here to the station, and told us he had to leave."
"Did he say why?"
"No, not really. He mumbled something about getting out before the winds died. That worried me a bit. It sounded psychotic. But other than that, he just insisted on leaving. We called security, just in case, but they got here too late. Even if they were here I don't know if we could have held him. He didn't seem to be thinking about hurting anyone or himself - I asked. He just kept saying that he had to leave. It wasn't clear in your intake report whether you assessed him as suicidal or homicidal. I heard that you had an incident with him during the intake... Is he violent?"
My palms were sweating. "There was potential for violence, but he seemed to be able to control himself. He's psychotic, though."
I could hear the next question coming, like I was caught in a bad psychiatric imitation of a Johnny Carson monologue.
"How psychotic is he?"
"You could fry an egg on it."
"Hm. That's not gonna help us," she said thoughtfully. "But if he's not clearly a danger to himself or anyone else, then he can't be involuntarily committed. He didn't seem so confused or disoriented that he might accidentally hurt himself. Besides, schizophrenics are walking the streets all the time out there. Even crazy people have rights."
My rationalizations were spreading. No one likes to deal with involuntary commitments. I kept quiet. I was busy biting the inside of my cheek.
"Well, O.K. then." She seemed uncertain. "We called his mother. She wasn't surprised that he left. She said she would drive over here to find him and take him home. Security is on the lookout. They'll encourage him to hang around, if they can, until his mother gets here. We told her to convince him to come back - and she agreed. But she was worried about something - something about shock treatment."
"I bet she's afraid we're going to blast her son for sure now. But maybe it's my brain that needs a dash of voltage."
Her face softened. She felt sorry for me. She knew that, ultimately, I would be held responsible. "Well, there's nothing else we can do at the moment, except wait and see what happens. You look tired. Why don't you get some sleep. You'll need it - for morning report."
"Yeah, right. The Spanish Inquisition. I look forward to it. But I don't think I can sleep. Maybe I'll get something to eat."
"Here," she said as she held something out to me. "Take a beeper."
I forced a smile. "I'll clip it to my ear."
As I walked towards the elevator I tried not to worry. What if he kills himself? I already had one patient who possibly committed suicide. What if he kills someone else? What if he kills me? I hesitated when I came to the next corner, and peered around the bend.
The hallways were empty. It was late. Normal people went home leaving us bleary-eyed drones to man the ship through the night. Hearing my footsteps echo off the wall sent an eerie shiver up my back. If ghosts linger in places of suffering, insanity, and death - then hospitals must be saturated with hauntings. During the day no one notices. The whirring of machines and medical lingo drowns them out.
Left, right, left, right, squirt, squirt, squirt.
I prayed there would be someone else in the elevator - someone innocuous. Fortunately, my prayers were answered. In fact, to my surprise, it was the guy I had seen in the hallway that afternoon - the one who performed the unsuccessful balancing act with the pile of books. Although I was glad to see him, my presence seemed to make him uncomfortable. He stared at his shoes and tapped his finger on the book tucked into his armpit. I could see the title. It was Giovacchini's Treatment of Primitive Mental States. I wondered who he was. A psychologist? Psychiatrist? I was surprised I hadn't seen him around before. One thing for sure - he was an intellectual. Probably a researcher, a professor. All the characteristics were right - rumpled suit, scuffed shoes, mussed up hair. Professors fall into two categories: the pumped-up, grandiose, narcissistic type - and the quiet, introverted, schizoid type. He fell into the latter group. He was benign, likable.
"A little light bedtime reading?" I asked as I pointed to his book.
He smiled. A sense of humor. "Yes, actually," he replied awkwardly, then fell silent. It was going to be up to me to keep the conversation rolling.
"I wonder, what IS a primitive mental state?"
He was still staring at his shoes when he answered. "Anything scientists can't relate to and don't understand."
The elevator stopped and split open.
"Bye," he said sheepishly and stepped out.
For a moment I thought about following him, to find out who he was, but I didn't. I got off the elevator at the next stop. The cafeteria was empty. Some of the lights were turned off, casting half of the circular room into shadow. Curiously, though, in the middle of the dark section there was one overhead lamp still on. It projected a small, dim dot of light into the center of the darkness. It beckoned me. I dropped off my knapsack at that spot and proceeded to the food counters.
A tall black man was wiping up with a rag. His hand glided slowly, methodically around the empty soup tureen, his attention totally focused on its polishing movements. There was no one else in sight. It made me uneasy.
I tapped a cup of coffee, picked out some cupcakes.
"How's it goin'?" I asked.
He held up his other hand. There was something in it. When he opened his fingers, things fell to the counter. It took me a few seconds to realize they were bones - chicken bones.
He studied them, then looked up at me. His eyes were dead, cold. He said nothing. Almost imperceptibly, he shook his head. It gave me the creeps. If the hospital was going to give ex-patients the night jobs in the cafeteria, why did it have to be someone who was catatonic? Couldn't they have gotten someone who was manic - someone who could cheer up or at least hype up the overnight staff?
There was still no one else in sight.
"I guess I'll give this money to you," I said as I held out some change. He just stared at me. I placed it down on the counter in front of him. "Take it easy."
When I got to my table and sat down, I looked back. He had resumed his polishing ritual.
I'm surprised they let that guy out of inpatient care. But then who am I to complain, right? Mobin walked right out of this place and I wasn't there to stop him. Again, the panic-provoking thought of his killing someone or himself seized me. Shit, that would be a nightmare! I couldn't take any more guilt.
I whipped the journal out of my knapsack, took a swig of coffee, and started to write.
What makes people commit suicide anyway? To escape an unbearable pain? To punish someone, including themselves? To feel embraced by death when no one else will embrace them? Some people think you have to be crazy to do it. You have to be in a dream state. Maybe not. Maybe it can be a clear, rational choice. But we therapists must always convince our patients otherwise. Suicide is a permanent solution to what is most likely a temporary problem. Right? Binswanger, a famous existential analyst in the early 1900s, once had a patient who suffered from all sorts of physical and social problems - a crippling disease, loss of loved ones, a failing professional life. They discussed his problems at length and finally decided there was only one solution - suicide. The patient carried out the decision. I wonder if third party payment covered that session.
I looked up. The black man was still polishing the countertops. Oddly, I now felt comfortable, even safe knowing that he was still there. I put my pen back to the page:
A memory comes back to me. At the park, after sunset, Kevin and I put our legs straight up onto the cyclone fence, our bare backs against the cool summer grass, our feet pointing at the stars. He is my best friend, a long time ago. We stare up into the night sky as we share preposterous stories of adventure and try to top each other's jokes. The real world of duties and responsibilities slips away. Our laughs dance up into the darkness, our imagination soars to the distant planets.
"Look," he says, pointing past our feet, up towards the darkness above. The sky spreads all around us, sparkling with a textured vista of stars, some bright and within reach, some faded and barely imaginable. They fill the endless expanse of time and space, penetrating to depths beyond the mind's grasp.
A cloak of silence falls over us. My ears strain but can gather no sound passing through the air, not even the distant highway traffic, or the wind in the trees. Only stillness - pure, clear stillness. It passes right through me.
"Look," the voice calls again - a voice I no longer recognize. At the periphery of my vision the sky shifts slightly. I blink. The entire field of stars begins to move, at first almost imperceptibly, then slowly, relentlessly, accelerates - like wheels, a huge, ghostly series of concentric swirls around a center of darkness. Humanless, it violates the ancient unconscious expectation that the stars will always look stationary, will always be dependable points of reference. I close my eyes to escape but the vision doesn't go away. The swirls move faster. My innards wrench. My mind won't accept it. Disoriented, frightened, I look to my friend. He is gone. I look up. The fence is gone. My legs and body are gone. Only the whirling of light and darkness around me, sucking me up, out of my consciousness, out of the boundaries of my known self. I'm falling, down, up, through the swirling funnel of stars, into the emptiness at its center, expanding and dissipating outward into the space around me. A sound pierces the void - a single pulsing tone, a song with only one note - the Song of the Sirens luring me to the Beyond, to my death.
I jolt upright in my seat. Holy shit! I was sleeping! Another dream! I try to focus on my surroundings. My heart is still racing. I'm in the cafeteria, at work. I'm O.K. It was just a dream.... But that noise, that pulsing tone - I still hear it.... The beeper! I'm being paged.
I fumble to switch it off, slump back into my chair, try to compose myself. The cafeteria is empty. The clock on the wall reads one minute after midnight.
I've got to get back to the unit.